Investigator Awards In Health Policy Research 53 Bay State Road
Boston University Health Policy Institute
Boston, MA 02215 		Tel: 1-617-353-9220, ext. 1
Fax: 1-617-353-9227
Email: rwjfihp@bu.edu
www.investigatorawards.org
www.rwjf.org
Investigators And Their Projects » Awards by Year:
Section Info
This section contains information about all of the projects and researchers that have been funded through the Investigator Awards program since the first grants were made in 1993. The indexes in this section can be used to identify investigators by name, area of expertise, or year of award. Throughout the site, you will find that each investigator’s name links to details including contact and project information.
»List Projects awarded in
Projects Awarded in 1994:
Investigator names link to complete details.
Ruth R. Faden, Ph.D., M.P.H.
G. Madison Powers, J.D., D. Phil.		Ethics and Allocation: The Foundations of American Health Care Policy
Award Year: 1994

»Show Abstract
Few authors have looked critically at both the moral foundations and conceptual underpinnings of welfare economics upon which analytic techniques in health care policy are based. This study examines the values and assumptions underlying alternative models of health care allocation cost-benefit, cost-effectiveness, and cost-utility and their application to health care policy. It addresses the implications for social justice associated with these methods and the need for practical guidelines in advance of their widespread utilization. The underlying assumptions of rational decision and social choice theory that connect the two in the context of health policy are also explored. Results reveal the moral tradeoffs entailed in choosing different methods for allocating resources in the context of decisions about eligibility, coverage, and reimbursement. The investigators' work provides greater understanding of these methods so that policymakers can choose among them with greater awareness of the ethical implications of their choices.
Martin Gaynor, Ph.D.
Deborah Haas-Wilson, Ph.D.		Antitrust Policy and the Transformation of Health Care Markets
Award Year: 1994

»Show Abstract
This study examines antitrust policy in the context of integrated provider networks. While increasing collaboration and integration of medical providers may be consistent with the goal of reducing health care costs, antitrust laws are written to promote and protect competition, not collaboration. Drs. Haas-Wilson and Gaynor take a close look at the role of antitrust policy in ensuring pro-competitive impacts of mergers, network affiliations, joint ventures, contractual arrangements, and health insurance purchasing alliances. A conceptual framework is developed to analyze competitive effects, focusing on: 1) the social welfare impacts of changes in structure and conduct in health care markets; 2) whether changes enhance efficiency or quality, or whether they facilitate collusion and market power; and, 3) appropriate antitrust policy if these changes result in lessened competition and a significant welfare loss. The findings provide policy guidance concerning when consolidation and/or collaboration should be encouraged or prohibited.
David Mechanic, Ph.D.Economic Constraints, Trust and Evolving Patient-Provider Relationships
Award Year: 1994

»Show Abstract
The public's trust in physicians is an essential aspect of health care delivery. As tensions grow between new medical possibilities and expenditure limits, innovative mechanisms are needed to settle disputes if litigation and other costly transactions are to be minimized. Dr. Mechanic uses trust as a conceptual frame to understand better evolving structures, possible mediating institutions, and the social and ethical implications of varying models of doctor-patient relationships. He examines strategies for rationing health care resources, achieving integration between acute and chronic disease models, and enhancing the compatibility of efforts to improve physical and behavioral health. The project synthesizes work on trust relations in medicine, building on theory and empirical research from several disciplines. Dr. Mechanic uses interviews and analysis of provider survey data to help extend the picture of how new practice arrangements affect trust. He also looks at how the English National Health Service makes and seeks to legitimize rationing decisions. Results shed light on the forces influencing medical care and suggest alternative approaches to inevitable dilemmas.
James A. Morone, Ph.D.Moralism, Politics, and the Construction of Health Policy
Award Year: 1994

»Show Abstract
Dr. Morone investigates how morality influences health politics and policy. He: 1) designs a model that suggests how the political process changes when actors define policy questions in moral terms - e.g., irresponsible behavior or undeserving beneficiaries; 2) applies this analytic framework to six major health policy issues; and 3) contributes to health policy by explaining the latent moral politics that underlie contemporary approaches and programs. The study focuses on illegal drugs, alcohol, tobacco, AIDS, universal health care coverage, and teen pregnancy. Using an historical approach, it shows how popular images of vice and virtue influence each issue and draws lessons across policy areas generally studied in isolation. Particular emphasis is placed on several themes including: the issue of race and the use of moral politics as a coded way to inject racial bias into health policy debates; variations on the question of education and treatment versus prohibition and punishment; and the role of stigma and stereotyping in the politics of health policy.
Constance A. Nathanson, Ph.D.Disease Prevention as Social Change: A Comparative Study of Public Health Policymaking in the U.S., Canada, Great Britain, and France
Award Year: 1994

»Show Abstract
This project explores social and political factors, which foster or impede effective public health policymaking, and the development of a sociological theory of change in parameters of health and disease. Historical and demographic research indicates that public health policies play a significant role in mortality decline and that these policies are the outcome of identifiable social and political processes. Dr. Nathanson examines: the roles of state characteristics, grass-roots social and/or political movements, and issue-specific social characteristics in public health policy adoption and implementation. These variables and their relative importance are investigated through comparative analysis of infant health, tuberculosis, sexually transmitted diseases/HIV infection, and smoking as they have evolved from the late nineteenth century to the present in the U.S., Canada, Great Britain, and France. Drawing from case studies, she clarifies the unique aspects of the U.S. experience in public health policymaking, highlighting its limits and possibilities.
Mark A. Peterson, Ph.D.Dynamic Institutions and National Health Care Policy Making
Award Year: 1994

»Show Abstract
Beginning with the New Deal, Dr. Peterson explores the ways in which political and governmental institutions respond to the stimulus for public action, direct the choice of policy alternatives, and are influenced by various leadership activities. In related projects, two distinct patterns of health care policymaking are studied. The first concentrates on systemic policy change, assessing the debate over comprehensive health care reform in the context of past failures. It emphasizes the role of macro-level changes in interest groups, Congress, legislative political parties, and the presidency in explaining both the enhanced prospects of comprehensive reform in the 1990s and barriers to change. The second deals with normal policy, investigating health policy ranging from incremental adjustments like direct reimbursement of nurse practitioners under Medicare to major issues, such as AIDS. In this realm, the explanation of policy outcomes emphasizes the role of micro-level interactions among elected and non-elected public officials, interest groups, policy specialists, and activists, which vary across policy communities and over time.
Marc A. Rodwin, J.D., Ph.D.Accountable Health Care: Competing Interests, Goals and Policy Approaches
Award Year: 1994

»Show Abstract
This project explores the quest for responsible health care by examining the accountability of physicians, administrators, and organizations to consumers of health care, payers, and the general public. Accountability is looked at in the context of managed care organizations. Particular emphasis is placed on examining tensions and trade-offs among competing parties, and how changes in health policy affect accountability. Dr. Rodwin clarifies the concept and use of accountability in various disciplines; describes how it became an issue in health policy and how thinking about accountability has evolved. He suggests ways to improve accountability in health care, drawing lessons from other fields, including education and law enforcement. Central to the study is a comparison of the pros and cons of five mechanisms for promoting accountability: ethics and informal norms; political voice or representation; financial controls and incentives; administrative processes; and law.
David B. Smith, Ph.D.The Racial Segregation of Health Care in the United States: Assessing the Legacy, Impact and Remedies
Award Year: 1994

»Show Abstract
This project ties together the history of racial segregation and discrimination in health care and efforts to end it through litigation and regulation. A history of racial segregation in health care and insights into the impacts of discrimination on discrepancies in access and outcomes is presented. Dr. Smith provides two illustrative case studies. One describes the patterns of use of maternity services in a metropolitan area. Another describes the problems in assuring nursing home compliance with the Civil Rights Act. Dr. Smith assesses current organizational, methodological and data gaps associated with enforcing compliance with Title VI of the Civil Rights Act through the courts and regulatory agencies. He also addresses possible approaches, through regulatory and health care reform, for responding to continuing discrepancies and segregation in more subtle forms. Results focus on the need for policy interventions to monitor bias and ensure that changes in the delivery system do not institutionalize patterns of discrimination.
Kenneth E. Warner, Ph.D.The Nature, Evolution, and Implications of Tobacco Policy in the United States
Award Year: 1994

»Show Abstract
Dr. Warner produces a detailed history of the rise and fall of cigarette smoking in the U.S. in the 20th century both as a social phenomenon and as a major determinant of trends in health and health care. Special attention is devoted to the roles of tobacco-control research and policy. Synthesizing the leading work in this field, he provides a comprehensive analysis of the nature, origins, and consequences of tobacco policy in the U.S. Lessons are drawn relevant to tobacco-control activists, policymakers, and the broader health promotion community as to what matters in health promotion policy and what affects its emergence in social discourse. The role of tobacco-control policy, its origins and uses, and the integration of policy research findings into policy advocacy, are also examined. The project makes a valuable contribution as interpretive social history and to understanding the development and analysis of health policy in the domain of self-affecting health behaviors.
David R. Williams, Ph.D.Inequality and Health: Patterns and Dynamics
Award Year: 1994

»Show Abstract
Dr. Williams addresses several major unresolved issues with regard to the relationship between socioeconomic status (SES) and health. Using the Panel Study of Income Dynamics, he examines the mechanisms and processes by which aspects of SES affect health status and prospectively predict mortality. Specifically, the study: 1) analyzes the extent to which SES differentials in mortality have been widening in recent decades; 2) provides understanding of the relative contribution of multiple indicators of SES to mortality; 3) identifies the health consequences of stability versus change in the history and patterning of SES over time; and 4) examines how the association between SES and mortality varies by race and gender. This information contributes significantly to understanding the health consequences of changes in the economic status of American families in recent years; the role of income relative to other SES indicators, such as occupation, education, and measures of poverty; and the most appropriate strategies for reducing inequalities in health status.